Basic Exam of the Shoulder

Question 1

What are the main steps of a basic shoulder exam?

Answer 1

Prepare patient
Hand hygiene
General inspection
Palpation
Testing active movements of shoulder
Testing movement of glenohumeral joint
Completing exam

Question 2

How do you prepare the patient?

Answer 2

Reason
Involves both shoulders
Remove clothes from waist up
Female patients can leave their bras on
Explain process as you go through each step
Clear instructions

Question 3

What do you do in a general inspection?

Answer 3

Inspect and compare shoulders from
- Anterior
- Lateral
- Posterior
Look for
- Swelling
- Redness
- Scars
- Muscle wasting
Ask about pain or discomfort

Question 4

What should you also do whilst palpating the shoulder

Answer 4

Watch patient’s face regularly

Question 5

How do you palpate the shoulder?

Answer 5

Start on unaffected side
Check for
- Tenderness
- Swelling
- Crepitus
- Warmth
Systematic approach
1. Sternoclavicular joint
2. Along clavicle to acromioclavicular joint
3. Move medially to corocoid process
4. Move inferiorly to anterior glenohumeral joint line
5. Long head of biceps tendon in bicipital groove
6. Posterior aspect of shoulder
   - Insertion of supraspinatus
   - Spine of scapula
   - Down to inferior pole
Repeat on other shoulder

Question 6

How do you test the active movements of the shoulder?

Answer 6

Stand in front of patient
Demonstrate movements you wish to test
Ask patient to reproduce movement
Compare movements of one shoulder with other
Ask if limitations due to pain/stiffness
If limitation of active movement, carefully check passive movement too

Question 7

How do you test abduction and adduction of the shoulder joint?

Answer 7

Rest arms by side of body
Lift arms in arc above head in coronal plane
Bring arms back down by side of body

Question 8

What is the normal range of abduction at the shoulder joint?

Answer 8

180 degrees

Question 9

How do you test flexion and extension of the shoulder joint?

Answer 9

Move arm from side of body up in sagittal plane

Move arm backwards in sagittal plane as far as you can

Question 10

What is the normal range of flexion at the shoulder joint?

Answer 10

180 degrees

Question 11

What is the normal range of extension at the shoulder joint?

Answer 11

70 degrees

Question 12

How do you test external rotation of the shoulder joint?

Answer 12

Flex arms at elbows to 90 degrees
Keep elbows at side
Move hands outwards in transverse plane as far as you can

Question 13

What is the normal range of external rotation at the shoulder joint?

Answer 13

90 degrees

Question 14

How do you test internal rotation of the shoulder joint?

Answer 14

Place hands behind back as far up their spine as they can go

Question 15

How far can you reach up your spine with a normal range of internal rotation?

Answer 15

Lower border of scapula/level of T7

Question 16

How do you test the movement of the glenohumeral joint?

Answer 16

Stand behind patient
Ask them to place straightened arm by side
Fix scapula with one hand
Move patient's arm up in abduction
Repeat on other shoulder

Question 17

What results in abduction at the shoulder joint?

Answer 17

Scapula rotation

Glenohumeral movement

Question 18

To what level is scapula rotation detectable?

Answer 18

45-90 degrees of abduction

Question 19

What does it mean if scapula rotation starts at angle less than 45 degrees?

Answer 19

Likely that glenohumeral movement limited